Maternal near miss in low‐resource areas

Abstract Objective To describe the Global Network Near‐Miss Maternal Mortality System and its application in seven sites. Methods In a population‐based study, pregnant women eligible for enrollment in the Maternal and Newborn Health Registry at seven sites (Democratic Republic of the Congo; Guatemala; Belagavi and Nagpur, India; Kenya; Pakistan; and Zambia) between January 2014 and April 2016 were screened to identify those likely to have a near‐miss event. The WHO maternal near‐miss criteria were modified for low‐resource settings. The ratio of near‐miss events to maternal deaths was calculated. Results Among 122 707 women screened, 18 307 (15.0%) had a potential near‐miss event, of whom 4866 (26.6%; 4.0% of all women) had a near‐miss maternal event. The overall maternal mortality ratio was 155 per 100 000 live births. The ratio of near‐miss events to maternal deaths was 26 to 1. The most common factors involved in near‐miss cases were the hematologic/coagulation system, infection, and cardiovascular system. Conclusion By using the Global Network Near‐Miss Maternal Mortality System, large numbers of women were screened for near‐miss events, including those delivering at home or a low‐level maternity clinic. The 4.0% incidence of near‐miss maternal mortality is similar to previously reported data. The ratio of 26 near‐miss cases to 1 maternal death suggests that near miss might evaluate the impact of interventions more efficiently than maternal mortality.